Biochemical Associations with Depression, Anxiety, and Stress in Hemodialysis: The Role of Albumin, Calcium, and β2-Microglobulin According to Gender.

Background

Psychological distress is common in hemodialysis patients and is linked to worse clinical outcomes and lower quality of life. Nutritional and inflammatory disturbances may impact emotional well-being. Gender likely acts as a biological and psychosocial modifier. This study examined the link between depression, anxiety, and stress in hemodialysis patients and a broad range of biochemical markers, focusing on gender as a main factor.

Methods

A cross-sectional study included 54 adults on maintenance hemodialysis at a hospital in Madrid, Spain. Emotional distress was measured using the DASS-21. Predialysis biochemical markers assessed were β2-microglobulin, albumin, hemoglobin, hematocrit, phosphorus, potassium, iron, calcium, and vitamin D. Statistical analyses included Spearman correlations, HC3-robust regressions with Gender × Biomarker interactions, false discovery rate correction (q = 0.10), penalized regressions (ridge/LASSO), partial least squares structural equation modeling (PLS-SEM), and mixed-cluster analysis.

Results

Women reported higher depression, anxiety, and stress, and had lower albumin, calcium, and vitamin D (p < 0.05). Depression was independently linked to female gender, lower calcium, and the Gender × β2-microglobulin interaction (adjusted R2 = 0.30). In PLS-SEM analysis, a latent global psychological distress measure was directly related to β2-microglobulin and inversely related to albumin and calcium (R2 = 0.47). Nutritional markers partly mediated the gender-distress link. Cluster analysis found three biopsychosocial profiles: metabolically balanced, catabolic-emotional, and resilient-compensated.

Conclusions

Gender shapes the relationships among inflammation, nutrition, and psychological distress in hemodialysis. Including gender-sensitive emotional and nutritional assessments in nephrology nursing could foster more personalized and practical care. Findings highlight the value of gender-aware psycho-nutritional screening in dialysis.